Provider Demographics
NPI:1518910835
Name:MIAN, ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:MIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940953
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0953
Mailing Address - Country:US
Mailing Address - Phone:407-960-5633
Mailing Address - Fax:407-960-5635
Practice Address - Street 1:166 LOOKOUT PL
Practice Address - Street 2:100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4496
Practice Address - Country:US
Practice Address - Phone:407-960-5633
Practice Address - Fax:407-960-5635
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME689742084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF99723Medicare UPIN
FL379735000Medicaid